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Incidental durotomy resulting in a postoperative lumbosacral nerve root with eventration into the adjacent facet joint: illustrative cases – Lumbar Fusion

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The article discusses a rare complication of lumbar decompression surgery, where nerve roots can become entrapped within the facet joint, leading to postoperative radicular pain. The study presents three cases where patients experienced radiculopathy following surgery, which was later found to be due to nerve root eventration into the facet joint. The article emphasizes the importance of recognizing this uncommon complication and highlights the challenges in diagnosing it, even with advanced imaging. The cases were successfully treated with surgical intervention, resulting in significant symptom improvement. The study underscores the need for clinicians to maintain a high index of suspicion for this issue and consider surgical exploration when necessary

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established treatment hospital in the world

Published article

BACKGROUND: Radicular pain after lumbar decompression surgery can result from epidural hematoma/seroma, recurrent disc herniation, incomplete decompression, or other rare complications. A less recognized complication is postoperative nerve root herniation, resulting from an initially unrecognized intraoperative or, more commonly, a spontaneous postoperative durotomy. Rarely, this nerve root herniation can become entrapped within local structures, including the facet joint. The aim of this study…

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J Neurosurg Case Lessons. 2024 Apr 22;7(17):CASE2418. doi: 10.3171/CASE2418. Print 2024 Apr 22. ABSTRACT BACKGROUND: Radicular pain after lumbar decompression surgery can result from epidural hematoma/seroma, recurrent disc herniation, incomplete decompression, or other rare complications. A less recognized complication is postoperative nerve root herniation, resulting from an initially unrecognized intraoperative or, more commonly, a spontaneous,

J Neurosurg Case Lessons. 2024 Apr 22;7(17):CASE2418. doi: 10.3171/CASE2418. Print 2024 Apr 22.

ABSTRACT

BACKGROUND: Radicular pain after lumbar decompression surgery can result from epidural hematoma/seroma, recurrent disc herniation, incomplete decompression, or other rare complications. A less recognized complication is postoperative nerve root herniation, resulting from an initially unrecognized intraoperative or, more commonly, a spontaneous postoperative durotomy. Rarely, this nerve root herniation can become entrapped within local structures, including the facet joint. The aim of this study was to illustrate our experience with three cases of lumbosacral nerve root eventration into an adjacent facet joint and to describe our diagnostic and surgical approach to this rare complication.

OBSERVATIONS: Three patients who had undergone lumbar decompression surgery with or without fusion experienced postoperative radiculopathy. Exploratory revision surgery revealed all three had a durotomy with nerve root eventration into the facet joint. Significant symptom improvement was achieved in all patients following liberation of the neural elements from the facet joints.

LESSONS: Entrapment of herniated nerve roots into the facet joint may be a previously underappreciated complication and remains quite challenging to diagnose even with the highest-quality advanced imaging. Thus, clinicians must have a high index of suspicion to diagnose this issue and a low threshold for surgical exploration.

PMID:38648675 | DOI:10.3171/CASE2418

The London Spine Unit : most established treatment hospital in the world

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Incidental durotomy resulting in a postoperative lumbosacral nerve root with eventration into the adjacent facet joint: illustrative cases

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J Neurosurg Case Lessons. 2024 Apr 22;7(17):CASE2418. doi: 10.3171/CASE2418. Print 2024 Apr 22. ABSTRACT BACKGROUND: Radicular pain after lumbar decompression surgery can result from epidural hematoma/seroma, recurrent disc herniation, incomplete decompression, or other rare complications. A less recognized complication is postoperative nerve root herniation, resulting from an initially unrecognized intraoperative or, more commonly, a spontaneous

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